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Individual

MR. JOSE MEDINA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
81 WILLOUGHBY ST, 4TH FLOOR, BROOKLYN, NY 11201-5291
(718) 522-3399
(718) 522-1888
Mailing address
81 WILLOUGHBY ST, 4TH FLOOR, BROOKLYN, NY 11201-5291
(718) 522-3399
(718) 522-1888

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
6801300
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6801300
LICENSE#
NY
Enumeration date
03/24/2010
Last updated
03/24/2010
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